Analysis: Circumcision urged in AIDS fight

SYDNEY, July 24 (UPI) -- Researchers at an Australian conference called this week for governments and societies to adopt and scale up the voluntary circumcision of adult men as a method of preventing infections that cause AIDS.

Although numerous studies -- including well-controlled, randomized clinical trials -- have shown that circumcision could result in more than a 50-percent reduction in transmitting HIV, the microbe that causes AIDS, the push to provide medical services for circumcision has been slow.

"In circumcision we have a proven efficacious HIV prevention intervention," said Robert Bailey, professor of epidemiology at the University of Illinois at Chicago.

"Circumcision is unique in that it is a one-time treatment, no booster is necessary, adherence once the procedure is complete, is complete," he said. "We must keep our eye on the prize: Male circumcision in east and southern Africa, and perhaps in other regions for selected populations, will save millions of lives."

In a lecture at the fourth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Sydney, Bailey said, "One cannot help but contemplate that if it were a drug or a compound or a shot with a fancy label, international agencies and donors would have been fighting to be the first to make it available many months, even years ago."

Studies suggest, he said, that cost-effectiveness of circumcision of men in areas of high HIV prevalence is exceptionally low, amounting to less than $200 per person.

"Let's finally take the turn from the long road of contemplation to the highway of action," Bailey said. "We must make safe, affordable, voluntary circumcision available now."

"It is extremely clear that we have an intervention that is inexpensive and effective," said Julio Montaner, director of clinical activities at the British Columbia Center for Excellence in HIV/AIDS at the University of British Columbia, told United Press International. "It has to be rationally determined where the intervention will be most useful."

He said that circumcision and other proven HIV/AIDS interventions need to be implemented now. "Inaction against HIV /AIDS could be considered as a crime against humanity," said Montaner, the president-elect of the International AIDS Society.

Bailey said that numerous epidemiological and observational studies had shown that circumcision was protective again HIV infection. He noted that in nations of Africa where HIV prevalence is the highest -- Swaziland, Botswana, Zimbabwe, Zambia -- the rate of male circumcision is less than 20 percent. Where rates of HIV infection in sub-Saharan Africa are low, circumcision rates exceed 80 percent, he said.

"In fact, no country with nearly universal circumcision coverage has ever had an adult HIV prevalence higher than 8 percent, including countries such as Cameroon where a 1997 survey found sexual behavior to be higher risk than that in countries with prevalence of around 25 percent," he said.

Bailey cited studies that indicated that if all the men in sub-Saharan Africa opted for circumcision, 2 million infections and 300,000 lives could be saved over 10 years, and that 5.7 million infections would be averted over 20 years.

While he acknowledged that 100-percent uptake of circumcision is unrealistic, other studies suggested that a 50 percent uptake in the South African city of Soweto could avert between 32,000 and 53,000 new infections over 20 years and HIV prevalence in that area would decrease from 23 percent to 14 percent.

"The faster we scale up, the more infections we can prevent," Bailey said. He acknowledged that the challenges to circumcision are multiple: It is only partially protective; there are safety issues such as making sure the procedure is done properly and that men do not engage in sex until complete healing has occurred; that it might be used as an excuse not to use condoms.

But despite the challenges he said that the procedure is enthusiastically supported by men and their partners in areas of high HIV prevalence.